腰麻-硬膜外联合麻醉用于分娩潜伏期镇痛的临床研究

A clinical study of combined spinal-epidural analgesia for latent phase of labor pain

目的探讨腰麻-硬膜外联合麻醉用于分娩潜伏期镇痛的可行性。方法选择200例ASAⅠ、Ⅱ级要求施行分娩镇痛的足月初产妇为观察组(A组),另选200例条件相仿但不给分娩镇痛为对照组(B组),A组在进入产程潜伏期后将2mL麻醉药(罗哌卡因2mg和芬太尼10μg)注入蛛网膜下隙。60min后连接PCA泵,胎儿娩出后停止硬膜外腔给药;B组按产科常规处理。观察、监测并记录镇痛效果(VAS)、神经阻滞评分(MBS)、产程时间、分娩方式、催产素的使用情况及新生儿Apgar评分。结果A组镇痛效果良好,镇痛前即刻VAS为(7.8±1.3)分,腰麻后10minVAS为(0.8±0.3)分,差异有显著性。A组未见下肢运动神经阻滞,MBS均为0。第2产程时间A组为(39.9±23.1)min,长于B组的(29.3±14.3)min(P<0.01),差异有显著性,但无临床意义;A组的第1、3产程时间、分娩方式、需静滴催产素加强宫缩的产妇及新生儿Apgar评分与B组比较差异无显著性(P>0.05)。结论腰麻-硬膜外联合麻醉用于分娩潜伏期镇痛效果确切,对产妇及新生儿无不良影响。

[Objective] To evaluate the practicability of combined spinal-epidural analgesia（CSEA）in nulliparous women for latent phase of labor pain. [Methods] 200 ASA physical status of Ⅰ or Ⅱ full-term nulliparous parturients were administered CSEA during latent phase of labor （group A） and 200 ASA physical status of Ⅰ or Ⅱ full-term nilliparous parturients were not as the control（group B）. In group A, ropivacaine 2 mg and fentanyl 10μg were injected into the subarachnoid space, which was followed, after 60 min, by PCEA with 0.125% ropivacaine and fentanyl （2 μg/mL） （basal infusion 6 mL/h, PCA bolus dose 2 mL, lockout time 10min）. The visual analogue scale （VAS） was obtained before and after CSEA. Degree of motor block was evaluated using modified bromage score （MBS） at the same time. The vital signs, duration of labor, mode of delivery, oxytocin consumption and the neonatal Apgar＇s score were recorded. [Results] The vital signs in group A were stable. Before labor analgesia with VAS score of （7.8±1.3）, 10 min after labor analgesia with VAS score of （0.8±0.3） （P 〈0.01）. There weren＇t motor block in group A during labor analgesia. The second-stage of group A experienced a significantly longer [（39.9±23.1） mini than that of group B [（29.3±14.3） mini （P 〈0.01）, but there wasn＇t clinical value. There were no differences in first-stage and third-stage laboring between two groups, and so were in mode of delivery, oxytocin consumption and neonatal Apgar＇s scores. [ Conclusion ] The analgesic delivery with CSEA is safe and highly effective in latent phase of labor. And it has no significant negative effects on the parturients and neonates.